Provider Demographics
NPI:1427390103
Name:NEIBAUR DENTAL, INC.
Entity Type:Organization
Organization Name:NEIBAUR DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:BRIGG
Authorized Official - Last Name:NEIBAUR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-378-9620
Mailing Address - Street 1:102 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5003
Mailing Address - Country:US
Mailing Address - Phone:907-456-6111
Mailing Address - Fax:907-456-6122
Practice Address - Street 1:102 10TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5003
Practice Address - Country:US
Practice Address - Phone:907-456-6111
Practice Address - Fax:907-456-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty